Is Music Therapy Covered by my Insurance?

In the state of Ohio the answer is “Probably Not”.  Direct reimbursement of Music Therapy services happens on a case by case basis and, to my knowledge, has not been successful in Ohio.  The number of successes nationwide is steadily increasing and DBC3 Music Therapy has several claims pending insurance approval here in Ohio (stay tuned).  If your music therapist is a medicaid provider it is possible to use your medicaid waivers for Music Therapy services, however, obtaining a medicaid provider number is not a common occurance for Music Therapists in the state of Ohio.  Medicare, to my knowledge, does not recognize music therapists among their listed providers and so does not reimburse Music Therapy.

My apologies if this seems negative but these are the current realities.  On the positive side there are several entities currently working to make reimbursement more of a reality, both on the state and federal levels.  If you are a potential music therapy client there are 2 things you can do to help get your insurance company to consider reimbursing Music Therapy services; 1) get a letter of medical necessity from your primary physician and 2) call your case manager and tell them you want Music Therapy services.  While this won’t guarantee reimbursement it will place the conversation on the table.

Neurologic Music Therapy and Reimbursement

While 3rd party reimbursement for Music Therapy is still an iffy proposition for many practitioners, Neurologic Music Therapy has been instrumental in helping to level the playing field, as it were.  NMT techniques are codified according to Current Procedural Terminology (CPT) and are defined diagnostically.  When submitting to a 3rd party payer a therapist must put the patient’s appropriate diagnosis code(s) and, often, a CPT code that represents the treatment utilized, and accepted as appropriate, for that diagnosis.  Being able to enter these when submitting for reimbursement allows Music Therapists to speak the same language as other therapists to the insurance companies.  While far from a guarantee and questions regarding treatment may still arise, it is one less obstacle Music Therapists have to face.